Splenectomy Does Not Cure the Thrombocytopenia of Systemic Lupus Erythematosus

Abstract

Fourteen patients with systemic lupus erythematosus had splenectomies done between 1960 and 1982 for treatment of severe thrombocytopenia. Thrombocytopenia persisted or recurred within 1 month postoperatively in five patients and within 6 months in three others. Three patients had late recurrence (18, 30, and 54 months after splenectomy); in two it was probably related to withdrawal of immunosuppressive agents or corticosteroids. Median lowest platelet count before splenectomy and median platelet count at relapse or failure of splenectomy were both 8000/microL. Only two patients maintained normal platelet counts without need for corticosteroids or other treatment. These results differ from those in patients with idiopathic thrombocytopenic purpura. Other treatments should be tried before splenectomy is done for thrombocytopenia in patients with systemic lupus erythematosus.

The ITP syndrome: pathogenic and clinical diversity

“…Patients with severe SLE are less likely to respond to splenectomy than those with primary ITP. 96 Reliance on splenectomy should be tempered by frequent requirements for corticosteroids or immunosuppressants to control other manifestations of SLE and is indicated when thrombocytopenia is severe, persistent, is the predominant reason for treatment, or if other tolerable options are ineffective and the underlying disease is otherwise controlled. 97 Posttransplantation: ITP-Tx.…”

Do the acute platelet responses of patients with immune thrombocytopenic purpura (ITP) to IV anti‐D and to IV gammaglobulin predict response to subsequent splenectomy?

“…Clinical prediction of a successful splenectomy has also been difficult [24]. Those patients with Evans syndrome [25], the combination of ITP and autoimmune hemolysis, and those with active systemic lupus erythematosus [26] (reviewed in reference 4) are thought to have lower response rates to splenectomy. Response to prednisone has been equivocal at best in predicting response to splenectomy [5,8,27].…”

Systemic Lupus Erythematosus-associated Thrombocytopenia in Pregnancy: Is Splenectomy Necessary at the Time of Delivery?

“…The third issue regards whether there is evidence to support the efficacy of splenectomy to treat thrombocytopenia associated with SLE and whether there are useful predictors to identify responders vs nonresponders to splenectomy in patients with SLE-associated thrombocytopenia in pregnant and nonpregnant patients. Hall et al 23 reviewed the efficacy of splenectomy to treat thrombocytopenia associated with SLE; they concluded that splenectomy is not effective at curing the thrombocytopenia observed in patients with SLE; therefore, they suggest that it should be used only as a very last resort after having exhausted all other therapeutic modalities. However, a more recent review of this issue from the Mayo Clinic shows that splenectomy is effective in treating SLE-associated thrombocytopenia by providing an 88% early partial or complete response and a 64% sustained response rate.…”